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General NPI Number Information
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NPI Number | 1992526313
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Entity Type | Organization
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Legal Business Name | 4LIFE HEALTHCARE LLC
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 44355 PREMIER PLZ STE 120
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City | ASHBURN
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State | VA
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Zip | 20147-5050
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Country | US
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Telephone | 703-826-5678
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Fax | 833-283-0249
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Provider Business Mailing Address
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Address Line | 41994 CEDAR POINT PL
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City | ALDIE
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State | VA
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Zip | 20105-2693
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Country | US
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Telephone | 703-826-5678
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Fax | 833-283-0249
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Authorized Official
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Title or Position | OWNER
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Name | DR. LARIJEAN ESTRADA-BROOKS
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Credential | DPT
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Telephone | 703-826-5678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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